Comprehensive Hematology and Transplantation: Rejection, Cardiac, Sickle Cell, Leukemia, and Lymphoma

Allograft

Tissue from a genetically dissimilar donor → higher rejection risk.

Graft vs Host Disease

Rare in solid organ transplant: donor immune cells attack the host.

Symptoms of Rejection

Fever, malaise, pain at incision, oliguria, hypertension, edema, vasculitis, progressive organ failure, and arterial narrowing.

Immunosuppressants

Medications required for life after renal transplant.

Triple Therapy

Corticosteroid + Antimetabolite + Calcineurin Inhibitor.

Rituximab

Targets B cells for immune modulation.

IVIG

Normalizes immune system, risk of anaphylaxis.

Risk Factors for Infection

Aggressive immunosuppression.

Hyperacute rejection

Occurs in less than 24 hours.

Chronic organ rejection

Progressive failure of the organ and fibrosis of blood vessels.

V-Tach

>180 bpm; With pulse → amiodarone or cardioversion; No pulse → CPR, shock, epi, amio.

AFib

Damage to the atria, inefficient emptying of atria, No P waves, irregular rhythm, risk for stroke.

Atrial Flutter

P wave, Sawtooth waves, risk stroke.

SVT

140-150 bpm; Tx = vagal maneuvers → adenosine → cardioversion.

PVCs

Caused by caffeine, nicotine, stress, ischemia, hypoxia, and electrolyte imbalance.

Bigeminy

Every other heartbeat.

Couplet

2 PVCs in a row.

Run

3 PVCs in a row.

Multifocal PVCs

PVCs that don't look the same.

Unifocal PVCs

PVCs that look the same.

VFib

No cardiac output; Tx = CPR, shock, epi, amiodarone.

Asystole

Flatline; Tx = CPR, epi, Hs & Ts; Do not shock.

Sinus bradycardia

A condition characterized by a slower than normal heart rate, often caused by lower metabolic need, hypothyroidism, or beta blockers.

Sinus tachycardia

A condition characterized by a faster than normal heart rate, often triggered by pain, stimulants, or dehydration.

PAC

Premature Atrial Contraction caused by stimulants, electrolyte imbalances (potassium), or cardiac ischemia, leading to a skipped heartbeat.

3rd degree Heart block

A condition where there is no relationship between P wave and R wave, indicating no conduction between the SA and AV nodes.

PR interval

The time interval between the onset of atrial depolarization and the onset of ventricular depolarization, normally ranging from 0.12 to 0.20 seconds.

Risk Factors for cardiac issues

Includes CAD, MI, electrolyte imbalance, stimulants, and dig toxicity.

Amiodarone

A medication used for atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.

Adenosine

A medication used for supraventricular tachycardia (SVT) with a short half-life.

Digoxin

A medication used for rate control in atrial fibrillation.

Warfarin

An anticoagulant used for stroke prevention in atrial fibrillation.

Sickle Cell Disease (SCD)

A genetic condition caused by HbS leading to sickling of cells, triggered by cold and lack of oxygen.

Symptoms of SCD

Includes pain crisis, anemia, jaundice, priapism, and stroke risk.

Crisis manifestations in SCD

Includes vaso-occlusive pain, splenic sequestration, and aplastic crisis.

Treatment for SCD

Includes oxygen, IV fluids, opioids, transfusions, and hydroxyurea.

CBC findings in SCD

Low hemoglobin, hematocrit, and RBC count; high reticulocyte and WBC count; normal MCU and platelet.

Diagnosis of SCD

Includes blood smear to reveal sickle cells, hemoglobin electrophoresis, and DNA analysis.

Nursing Interventions for SCD

Includes pain management, hydration, oxygen, infection prevention, and cardiovascular and neuro assessment.

Leukemia

A malignant proliferation of white blood cells.

Symptoms of Leukemia

Includes frequent infections, enlarged lymph nodes, liver and spleen, weakness, fatigue, fever, night sweats, and bleeding.

Treatment for Leukemia

Includes chemotherapy, stem cell transplant, and monoclonal antibodies such as rituximab.

Diagnosis of Leukemia

Includes bone marrow biopsy showing a large number of immature leukocytes.

Risk Factors for Leukemia

Includes radiation, benzene exposure, family history, and immunodeficiency.

Bone marrow biopsy

Large number of immature leukocytes.

Nursing Interventions for Leukemia

Neutropenic precautions. Monitor bleeding & infection. Chemo safety & patient/family support.

Lymphoma

Malignancy of lymphatic system (Hodgkin vs Non-Hodgkin). Presents as a solid tumor.

Symptoms of Lymphoma

Painless lymph node swelling, fever, night sweats, weight loss.

Clinical Manifestation of Lymphoma

Enlarged, nontender, firm and movable lymph nodes in the neck, axillary or groin area.

Reed Sternberg Cells

Characteristic cells found in Hodgkin lymphoma.

Treatment for Lymphoma

Chemo, radiation, stem cell transplant, rituximab.

Medications for Lymphoma

Rituximab, IVIG.

Risk Factors for Lymphoma

Immunodeficiency, EBV, family history.

Nursing Interventions for Lymphoma

Monitor for tumor lysis syndrome. Manage fatigue, infection prevention. Psychosocial support.

Pacemakers

Only for sinus bradycardia unresponsive to atropine.

Stroke Risk

Highest with AFib/flutter.

ACLS Sequence

Assess responsiveness → CPR/shock/meds.

PVC Causes

Stimulants, ischemia, hypoxia, dig toxicity.

Erythropoietin alfa

↑ RBCs; monitor Hgb, BP.

Hydroxyurea

Sickle cell; ↑ HbF, monitor CBC.

Milrinone

Inotrope for HF, monitor BP, arrhythmias.

Vasopressin

For shock; potent vasoconstrictor.

Nitroglycerin

Vasodilator for chest pain; SL works fast, lowers BP.

Corticosteroids

A class of steroid hormones produced in the adrenal cortex.

Antimetabolites

Substances that interfere with the metabolic processes of cells.

Antiproliferative drugs

Drugs that prevent the reproduction of B and T cells.

Cell cycle specific

Drugs that attack at very specific phases in the cell cycle.

Azathioprine

A medication used as an immunosuppressant.

Mycophenolic acids

Includes mycophenolate mofetil, used as an immunosuppressant.

Calcineurin Inhibitors

Drugs that inhibit the proliferation of helper T cells and the expression of cytokines.

Cyclosporine

A calcineurin inhibitor used in kidney transplants.

Tacrolimus

A calcineurin inhibitor used in kidney transplants.

Chronic nephrotoxicity

A side effect associated with calcineurin inhibitors.

Monoclonal Antibodies

Lab-made antibodies designed to react directly against certain proteins.

Synergy

The interaction of two or more agents to produce a combined effect greater than the sum of their separate effects.

Patient Characteristics

Factors that influence patient care including stability, vulnerability, resiliency, and complexity.

Stability

The current status of a patient.

Vulnerability

The risk associated with a patient's condition.

Resiliency

The ability to bounce back with coping mechanisms and return to functioning.

Complexity

The intricate entanglement of two or more systems (body, family therapies).

Novice to Expert theory

A framework describing the progression of skills and confidence in practice.

Novice

A beginner who lacks confidence and requires continual cues.

Advanced beginner

A practitioner with marginally acceptable performance and prior experience.

Competent

A practitioner who is efficient, coordinated, and confident in their actions.

Proficient

A charge nurse who sees the whole patient and learns from experiences.

Expert

A practitioner who understands the whole picture and can handle any situation.

Clinical judgement

Assessing a situation based on education and experience.

Collaboration

Working with others to promote well-being.

Clinical inquiry

Guided by the question 'why'.

Transfused platelets

Not beneficial because they are rapidly destroyed in the body.

Multiple myeloma

A condition characterized by an imbalance leading to hypercalcemia.

Hodgkin lymphoma

A type of cancer characterized by the presence of Reed Sternberg cells.

Atropine

Used to treat symptomatic bradycardia.

Restrictive cardiomyopathy

A condition where scar tissue or deposits harden the heart and inhibit relaxation between beats.

Hematopoiesis

The process of blood cell formation occurring in the liver and spleen.

RBC production

Requires vitamin B12 and folic acid to make more red blood cells.

Anemia

A condition characterized by a deficiency of red blood cells.

Hypoproliferative anemia

A defect in the production of red blood cells.

Hemolytic anemia

Characterized by the excess destruction of red blood cells.